Managing Dementia-Related Outbursts Through Redirection and Relearning

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Some things you never forget how to do, like riding a bike. Although that’s not necessarily true for Alzheimer’s and dementia patients, this concept is the basis for a technique that thwarts anxious behaviors by directing attention to familiar activities or things enjoyed in the past.

AnnaMarie Barba is the director of Summer House, a memory care unit within Walnut Village continuing care retirement community in Anaheim, California. She has worked with Alzheimer’s and dementia patients for many years and in various senior living settings, but she is always looking for new techniques to calm patients’ minds and redirect their attention during times of anxiety, agitation or aggression.

Attempting to complete daily activities can be difficult enough for Alzheimer’s and dementia patients. When it comes to learning a completely new skill, the challenge can result in extreme frustration. “For those suffering from cognitive impairment, learning new things can be over-stimulating, creating stress and agitation,” Barba explains. “I started thinking, why not use something that’s familiar to them? Something that has personal meaning?”

As a result, when a resident at Summer House is irritated or anxious, Barba uses redirection and relearning techniques to focus their attention on familiar activities or tasks that the person used to enjoy in the past. Re-directing has proven to be an effective technique that does seem to have a soothing, therapeutic effect.

Recreating Familiar Surroundings Assists in Redirection

As part of the re-learning activities, Summer House has created immersive “life skill stations” in the community. These areas are set up with props to look like a baby nursery, an office space, a workshop and other classic settings that residents may have frequented throughout their lives. Each simulated environment serves as a visual reminder of past roles, careers and life events. For example, the baby station has a crib with dolls, a stroller, a rocking chair and other items commonly found in a nursery. By gently being guided to this life skills station when agitated, a resident may suddenly remember her role as a mother. She may sit in the rocker and begin a conversation about raising her children. Redirecting the mind by focusing on familiar surroundings brings back memories of happier times and often stops fretful behaviors.

“With Alzheimer’s and dementia patients, we are constantly re-acclimating them to their environment. Our goal is to make life more familiar through sight, smell and touch,” Barba says. One Summer House resident spent a lifetime gardening and planting roses. To help her remain engaged and maintain a sense of purpose, she has been given her own garden plot to tend to. When she is feeling confused or upset, the staff know to direct her to her plants and work through gardening techniques together.

Another resident enjoyed playing the piano in his youth. Today, he plays the community piano and even puts on mini-concerts for the other residents. “It’s been my experience that relearning is equally, if not more effective than learning techniques,” Barba posits. “Relearning an activity is more valuable for Alzheimer’s patients than learning a new one. It still provides a challenge, but it is one that’s within their comfort zone.”

But does the technique really work? According to Barba, the proof is in the subtle signs she sees in her residents. “It’s often the non-verbal clues that show the dementia-related behaviors are subsiding. Their shoulders start to relax, their fingers stop fidgeting and their eyes become more focused.”

Re-learning techniques have even reduced medication usage for some residents at Summer House. Instead of giving a patient medication for anxiety, they’ll be directed to their flower bed, piano or “office space.” They’ll become refocused and redirected and will calm down naturally.

Redirection and Relearning Must Be Personalized

Redirection techniques must be tailored to each individual. So, Barba meets with each new resident upon their arrival to learn as much as she can about that person: his or her favorite foods and hobbies and important personal and family events. She then develops a unique care strategy focused on activities that have played a significant role in their life.

Much of the initial input comes from family members. “I’ll ask specific questions about their loved one’s life, like what their hobbies are or what their favorite thing to do on a Sunday is,” explains Barba. This is one of the many benefits of families actively participating in the memory care selection and move-in processes and continuing to visit regularly after the transition is complete. Visitors can help staff fill in valuable knowledge gaps about their residents, which has the ability to greatly enhance the care they provide.

Understanding the Causes of Dementia Outbursts

The Copper Ridge Institute, a residential care community for those with Alzheimer’s and related dementias in Sykesville, Maryland, is also sensitive to their residents’ abilities and limitations. “Outbursts and agitation could be a sign that a current activity is too difficult or too overwhelming for a patient,” says Cindy Steele, RN, BSN, MPH, the nurse scholar and behavioral management specialist for Copper Ridge and assistant professor of psychiatry at Johns Hopkins University School of Medicine. “Switching to a less complicated and more familiar task may lessen their agitation because it provides a sense of accomplishment, morale and self-worth.”

Steele emphasizes that it is important to get to the bottom of why the person is having an outburst, and address whatever is causing it. For example, a patient may be unsuccessfully trying to communicate pain or discomfort stemming from a physical problem, such as a headache or urinary tract infection (UTI). Or it may be something as simple as their surroundings being too cold, too hot or too noisy. Treating the underlying issue(s) is the best way to alleviate dementia-related behaviors.

Read: 5 Causes of Alzheimer’s Outbursts

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3 Comments

You have my absolute respect because I know first hand how hard this is.
My Mom was extremely abusive when we began this journey over 5 years ago. Mean as a snake. Actually, I hate to demean the snake.
It took her about 18 months to even smile at me.
I figured out that her biggest issue was the fear of abandonment and I developed the 'safe and sound' routine. I still tell her a lot: you are safe and sound. Belly's full, clean and dry, clean clothes, chocolate pudding, etc. etc. When she would get awful I would holler back at her that no matter how big of a jackass she wanted to be I wasn't going to leave her, so knock it off. I made up my mind that I would literally just wear her out. You know the tv show Survivor? Outwit, outlast and whatever the other one is, outplay, outhouse, whatever, you take my point.
At this stage of the game, I feel as if I have tamed a feral animal. Her anger is gone but some of the fears are still there and all I can do is be there and say, you're safe and sound.. let's have some tea.

All dementias are different in the way the person reacts. What worked for me could very well not work for you, but may be worth a try. My mother and I had a sad, distant relationship because of so many stupid reasons and I would never have believed that we could have pulled this off but we have.

The other thing I kept saying to her is: we only have this moment. That's it. All we have is this. So quit being a pill.

If you think of taming a feral animal, food is involved. Kind words and a sliced apple, etc. Food goes a long way as currency for the old folks.

I know it's hard to be nice to someone who is a total jerk to you, but it might work and you might be able to have a peaceful home with an elderly person with special needs in it as opposed to the insanity and heartbreak I know you are living in now.

Good luck and please don't forget to find things in your situation that are funny. You know they're there, just go ahead and give voice to it to help keep YOU sane.

My Mom can crap her pants, try to hide the pants and after I pull it all together with the bath for Mom, pants rinsed out, load in the machine (no pun intended) bed changed out, clean pjs, etc. She'll stand at the bed with a puss on picking the 'lint' off of the clean bedspread. How dare I place a bedspread that has lint on it. That's totally worth a laugh.

Talk to you soon,
Bobbie
I'm comforted to know that others too are getting abused by their mother. I agree you learn to cope although it is never pleasant. My mother is so old now that she wears out easily so the tirades don't go on for hours like they used to when I was a kid. Also she can't focus and sometimes forgets why she is angry. Distraction is the best. I like the idea of the food distraction.

Although it does no good, I wonder why these people are still with us. Nature is not being very efficient. I try to remember that it will end eventually. God help us all.
I am dealing with my mother-in-law's abusive behavior. She has a history of causing family problems even before the advent of her dementia. She has disrupted our home since she moved in one year ago. She made the last year of my dad's life miserable, and now is focusing her hate on me. My father moved in with us first almost 12 years ago, and just recently passed away.
She feels safest with my husband, which I guess is understandable. I am coping by insisting on 4 hour respite stays of once per week, weekend stays once per month, and week long stays once or twice per year. I don't know if this will be enough, but it is a start. I refuse to expose myself to her abuse, which unfortunately puts more pressure on my husband. I would like to see her move out to be honest, but I won't force that decision. I can say I won't ever forget the grief she caused my father.